Logistical Complexity Research Articles

A Review of Vessel Time of Arrival Prediction on Waterway Networks: Current Trends, Open Issues, and Future Directions

With the vast majority of global trade volume and value reliant on maritime transport, accurate prediction of vessel estimated time of arrival (ETA) is crucial for optimizing supply chain efficiency and managing logistical complexities in port operations. This review paper systematically examines the current state of research and practices in the field of vessel ETA prediction, highlighting significant trends, methodologies, and technologies. It explores various approaches, including classical methods, machine learning and deep learning algorithms, and hybrid methods, developed to enhance the accuracy and reliability of vessel travel time and arrival time predictions. Additionally, this paper categorizes key influencing factors and metrics, and identifies open issues and challenges within current prediction models. Concluding with proposed future research directions aimed at addressing the identified gaps and leveraging technological advancements, this review emphasizes the importance of fostering innovation in maritime ETA prediction systems, particularly within the framework of Intelligent Transportation Systems (ITSs) and maritime logistics. By applying a systematic literature review (SLR) methodology and conducting an in-depth evaluation, the results provide a comprehensive overview of vessel ETA prediction for researchers, practitioners, and policy makers involved in maritime transport and logistics, and offer insights into the potential for improved efficiency, safety, and environmental sustainability in waterway networks.

Global mobility reimagined: Navigating traditional and virtual study abroad management

Academic mobility has become essential to higher education, fostering global collaboration, cross-cultural engagement, language learning, and transformative educational experiences. Programs such as Erasmus+, UMAP, and Global Virtual Exchange enable millions of students, educators, and administrators to navigate the complexities of crossing borders—both physical and virtual—broadening perspectives, fostering international connections, and enhancing educational outcomes. However, these initiatives continue to encounter significant challenges, such as logistical complexities, a shortage of specialized support personnel, and the pressing need for staff development and effective digital tool integration. Additionally, identity and inclusivity remain central to the discussion, highlighting the importance of equity and critical engagement in mobility programs. To meet these demands, institutions are reshaping their frameworks and policies to ensure accessibility, cultural sensitivity, and effectiveness in mobility programs across the globe.

Resident Experiences at a Community Hospital Caring for Patients Who Are Incarcerated.

There is no standardized curriculum that teaches medical residents to navigate the ethical and logistical complexities of bedside care delivery to patients who are incarcerated. In this article, we describe resident physician bedside experiences at a community teaching hospital caring for patients who are incarcerated. From 2022 to 2023, residents in emergency medicine, general surgery, internal medicine, and obstetrics and gynecology were offered an anonymous survey, self-administered via REDCap software, to explore their experiences caring for this patient population. Of 168 resident physicians, 78 (46.4%) completed the survey. The majority were cisgender women (62.3%), 20 to 30 years old (78.2%), and White (70.5%). Of these residents, 98.7% had cared for a patient who was incarcerated or in custody, yet only 15.4% reported receiving formal education regarding caring for this patient population, and only 24.4% were aware of relevant institutional policies. Qualitative analysis revealed themes including barriers to care, permission and authorization, conditional treatment, inconsistency, and conflict. Resident curricula that target knowledge gaps related to procedure and policy and address ethical concerns at the bedside may improve the clinical learning environment and lead to more consistent, equitable care delivery for patients who are incarcerated.

Identification of the conditions and minimum requirements necessary for the release of autologous fresh CAR T-cell products under hospital exemption: a position paper from the WP-bioproduction of the UNITC consortium.

The accessibility of CAR-T cells in centralized production models faces significant challenges, primarily stemming from logistical complexities and prohibitive costs. However, European Regulation EC No. 1394/2007 introduced a pivotal provision known as the hospital exemption. This exemption enables academic institutions to produce ATMPs, including autologous CAR-T cells, under GMP conditions tailored to specific needs. In response to this regulatory framework, our work group has launched a guideline initiative. This endeavor aims to bolster academic CAR T-cell manufacturing by implementing strategic workshops that serve a dual purpose: standardizing production processes and ensuring both efficacy and safety standards are met. This inaugural focused on delineating criteria for the release of fresh CAR-T cell batches. Key emphases included thorough product characterization, stringent safety and potency evaluations. These criteria are essential for compliance with regulatory mandates and aligning with industry best practices. Notably, the release of initial CAR T-cell batches will be facilitated through provisional certification, with final certification contingent upon the acquisition of comprehensive analytical control results. This procedural framework adheres to methodologies endorsed by the SFGM-TC and the EBMT. Such adherence underscores a commitment to harmonizing practices across academic manufacturing facilities, thus fortifying the accessibility, efficacy, and safety of point-of-care units.

Data-Driven Order Consolidation with Vehicle Routing Optimization

This study compares time-based and quantity-based consolidation strategies within the Vehicle Routing Problem (VRP) framework to optimize supplier profitability and logistical efficiency. The time-based model consolidates deliveries at fixed intervals, offering predictable routes, reduced customer wait times, and cost efficiency in stable markets. Conversely, the quantity-based model dynamically adjusts delivery volumes to meet fluctuating demand, providing flexibility in dynamic environments but potentially increasing long-term costs due to logistical complexity. Using a mixed-integer linear programming (MILP) model, sensitivity analyses, and scenario-based experiments, the study demonstrates that the time-based model excels in stable conditions, while the quantity-based model performs better in highly variable demand scenarios. These findings provide actionable insights for selecting consolidation strategies that optimize delivery operations and enhance supply chain performance based on market dynamics.

Neighborhood Social Vulnerability and Access to Expedited Partner Therapy Prescriptions: A Secret Shopper Audit Survey.

Sexually transmitted infections (STIs) disproportionately impact populations with higher social vulnerability. Expedited Partner Therapy (EPT), which allows the treatment of partners without requiring a medical visit, reduces STI reinfection rates and expands treatment access for underserved groups. However, EPT remains underutilized, particularly in the electronic prescription era, which introduces logistical complexities. Previous studies highlight low pharmacist awareness of EPT, but few have assessed its real world availability in pharmacies or how accessibility varies by socioeconomic subcomponent of the Social Vulnerability Index (SVI). This study aimed to evaluate pharmacist awareness and willingness to dispense electronic, nameless EPT prescriptions in New York City (NYC) pharmacies and examine how these outcomes vary by the socioeconomic factors of the pharmacy's location. A cross-sectional study of 347 randomly sampled NYC pharmacies was conducted using a telephone-based secret shopper approach. Research associates posed as patients seeking to fill hypothetical EPT prescriptions to assess pharmacist awareness, willingness to dispense, and insurance acceptability. Multivariable logistic regression models evaluated the association between EPT awareness and willingness with SVI, adjusting for pharmacy type, neighborhood location, and local chlamydia rates. Among surveyed pharmacies, 40% (134/335) of pharmacists were aware of EPT, and only 30% (100/333) were willing to fill nameless prescriptions. Non-chain pharmacies were significantly less likely to be aware of EPT compared to national chains (34% vs. 54%, p=0.02). The most common dispensing approach was filling prescriptions under the index patient's name (34%, 114/335), with most pharmacies (86%, 179/208) accepting insurance. Only 30% (100/333) of pharmacists were willing to dispense nameless EPT prescriptions. Most pharmacists' methods of dispensing EPT prescriptions did not follow NY state EPT guidelines (54%, n=113). The most frequent reasons for refusal included unfamiliarity with EPT (62%, 66/107) and the incorrect belief that patient names were legally required (28%, 30/107). Adjusted regression showed increased odds of awareness of EPT in areas with the highest socioeconomic SVI quartile compared to the lowest quartile (odds ratio 3.7; 95% CI 1.4-10.8), though willingness to fill prescriptions did not differ by SVI (p=0.35). Despite higher pharmacist awareness of EPT in more socioeconomically vulnerable areas, willingness to dispense nameless prescriptions remains low across NYC pharmacies. Independent pharmacies demonstrated particularly low awareness and engagement with EPT. These findings underscore the need for targeted pharmacist education, system-level interventions to streamline EPT dispensing, and enhanced training to ensure guideline adherence, particularly in high-need areas. Addressing these barriers could reduce STI disparities and improve public health outcomes.

Implementing Advanced Analytics for Optimizing Food Supply Chain Logistics and Efficiency

The global food supply chain faces significant challenges in ensuring efficiency and minimizing disruptions, especially in the face of unexpected events, fluctuating demand, and logistical complexities. Implementing advanced analytics within food supply chains can transform operational dynamics, enabling precise prediction of potential disruptions and enhancing logistics efficiency. This study proposes a robust framework that leverages machine learning algorithms to forecast disruptions—such as delays in transport, shifts in consumer demand, or adverse weather conditions—and to optimize the logistics flow accordingly. By incorporating predictive modeling and real-time data analysis, this framework aims to enhance decision-making capabilities across various stages of the supply chain, from production and warehousing to transportation and delivery. The proposed framework utilizes a combination of supervised learning for demand forecasting and unsupervised learning for anomaly detection, enabling early identification of potential logistical challenges. Furthermore, integrating these analytics with real-time data sources, such as IoT sensors and satellite imagery, facilitates a comprehensive view of supply chain status, thereby increasing responsiveness and adaptability to unforeseen events. The potential future integration of this framework with autonomous delivery systems, such as drones or autonomous vehicles, could further streamline last-mile logistics, reducing both cost and delivery time while maintaining the quality and safety of perishable goods. This study not only demonstrates the immediate benefits of machine learning-driven predictive analytics but also discusses the scalability and flexibility of this approach for broader applications within global food systems. Future research can explore enhancements in algorithmic accuracy and integration with blockchain for traceability, supporting transparent, resilient, and highly efficient food supply chains. The integration of autonomous delivery systems will additionally be a key focus for ensuring seamless, reliable, and sustainable logistics operations in a rapidly evolving food industry landscape.

The role of FDI and energy intensity upon the consolidation of circular economies among the European Union.

This manuscript critically examines the intricate interplay between diverse foreign direct investment (FDI) flows, energy intensity, and their consequential effects on circular economies (CEs), specifically in terms of the waste recycling ratio, within the member states of the European Union over the period spanning from 2000 to 2021. Our findings substantiate that inflows and outflows of FDI have different implications for waste recycling, where an increase of 1% OFDI implies an increase of recycling ratio by 0.03%, a relationship that is potentially contingent upon the inherent characteristics of the flow itself in relation to its contributions to local productivity dynamics. In this vein, the influx of FDI, which is associated with amplified capital inputs and heightened productivity levels, is observed to exert a dampening effect on recycling capabilities, by an average of 0.01% for every 1% change. Conversely, the outflow of FDI entails reduced capital inputs, thereby curbing waste generation resulting from enhanced productivity capacities. Moreover, diminished energy intensity exerts a positive influence on the recycling ratio, thereby fostering the advancement of CE. To capitalize on their locational advantages, it is recommended that the European Union proactively foster the development of specialized zones that concentrate inflows of FDI, thereby facilitating the logistical complexities associated with waste recycling arising from FDI-driven productive activities. Such strategic initiatives hold the potential to contribute to heightened resource efficiency within the broader productivity relationship.

An Analysis on Logistic Management Distribution channel with respect to Varun Beverages at Mamandur, Tamil Nadu

Logistics management is a cornerstone of operational success, especially in industries with complex supply chains like beverages. Varun Beverages, a leading bottler of PepsiCo products, is known for its extensive distribution network, spanning rural and urban markets in India and internationally. This study aims to critically evaluate the logistics and distribution strategies of Varun Beverages, examining their effectiveness, challenges, and opportunities for improvement. By combining qualitative and quantitative research methods, the study will offer actionable insights to optimize logistics operations while contributing to the academic discourse in supply chain management. Assess relationships between categorical variables, such as market types (urban/rural) and distribution challenges. To analyse the research used a primary data like questionnaire and secondary data are taken from company and research paper and Chi-Square Test as a statistical tool for analysing categorical data, such as investor preference. Varun Beverages Limited, a key partner of PepsiCo, manages an extensive and diverse distribution network that serves a wide variety of markets, ranging from densely populated urban areas to remote rural regions across multiple countries. This network requires robust logistics strategies to address unique challenges such as fluctuating consumer demand, regional market conditions, and logistical complexities. Keywords: Logistics Management, Distribution Channels Varun Beverages, Supply Chain Resilience, Digital Transformation

DIGITALIZATION OF ECONOMIC AND LOGISTICS SYSTEMS: CREATION AND IMPLEMENTATION OF A CLUSTER HUB

The study includes an analysis of the theoretical aspects of digitization, definition of the concept of the cluster hubs, as well as consideration of the possibilities of their implementation to increase competitiveness and optimization of logistics processes. The article analyzes the modern interpretation of definitions common in the economic scientific environment: digitization, a systematic approach to the study and implementation of digitization advantages in practical activities, digitization of economic and logistics systems as separate categories and their interconnection in one structural component, the logistics hub; the introduction into the economic use of the term «cluster hub» for the logistics complex is substantiated and the option of its creation for Ukraine is proposed, taking into account the current military situation in the country and the post-war revival of its economy. The impact of the modern military and related crisis in the economy of Ukraine on business entities as a consequence of russia’s military aggression is substantiated, which requires the search for new ways of exiting the country’s economy from the current situation. It was determined that the development of the post-war economy of Ukraine cannot occur as a change of the individual subjects, but only in a holistic system of such development, where economic and logistical connections can be managed only in its (system) composition. The system is regulated by modern IT technologies, business process models, information communications, etc. It was determined that the movement of large volumes of goods in the modern wartime, and in the near future in the postwar period, is not possible by conventional means. The previously regulated logistic ways of movement do not correspond to the situation, therefore the use of the latest tools, methods, methods of digitization and IT technologies are important ways of solving the issues. The directions of the digitalization system solution to the problem of delivery, movement of goods, in particular, the creation of a logistics hub (including a cluster hub) that will contribute to the combination of elements of the economic and logistics system are identified: the creation of such a hub on the basis of the airport near the city of Vinnytsia.

Evaluating the Safety Climate in Construction Projects: A Longitudinal Mixed-Methods Study

Safety climate has been extensively studied using survey-based approaches, providing significant insights into safety perceptions and behaviors. However, understanding its dynamics in construction projects requires methods that address temporal and trade-specific variability. This study employs a longitudinal, mixed-methods design to explore safety climate dynamics. Quantitative data analyzed with ANOVA revealed stable overall safety climate scores across project phases, while Item Response Theory (IRT) identified survey items sensitive to safety climate changes. Positive perceptions were associated with management commitment and regular safety meetings, while negative perceptions highlighted challenges such as workplace congestion and impractical safety rules. Qualitative data from semi-structured interviews uncovered trade-specific and phase-specific safety challenges, including issues tied to site logistics and workforce dynamics. For instance, transitioning from structural to interior work introduced congestion-related risks and logistical complexities, underscoring the need for phase-adapted strategies. This combination of quantitative stability and qualitative variability provides empirical evidence of safety climate dynamics in construction. The findings emphasize the importance of tailoring safety interventions to address trade-specific and phase-specific risks. This study advances the understanding of the safety climate in dynamic work environments and offers actionable recommendations for improving construction safety management through targeted, proactive strategies.

Novel Dynamic Organ Storage System Enhances Liver Graft Function in a Porcine Donation After Circulatory Death Model.

Donation after circulatory death (DCD) livers face increased risks of critical complications when preserved with static cold storage (SCS). Although machine perfusion (MP) may mitigate these risks, its cost and logistical complexity limit widespread application. We developed the Dynamic Organ Storage System (DOSS), which delivers oxygenated perfusate at 10°C with minimal electrical power requirement and allows real-time effluent sampling in a portable cooler. In a porcine DCD model, livers were preserved using DOSS or SCS for 10 hours and evaluated with 4 hours of normothermic MP, with n = 5 per group. After 4 hours of normothermic MP, the DOSS group demonstrated significantly lower perfusate lactate (p = 0.023), increased perfusate fibrinogen (p = 0.005), higher oxygen consumption (p = 0.018), greater bile production (p = 0.013), higher bile bicarbonate levels (p = 0.035) and bile/perfusate sodium ratio (p = 0.002), and lower hepatic arterial resistance after phenylephrine administration (p = 0.018). Histological analysis showed lower apoptotic markers in DOSS-preserved livers, with fewer cleaved caspase-3 (p = 0.039) and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick-end labeling (TUNEL; p = 0.009) positive cells. These findings suggest that DOSS can enhance DCD allograft function during transport, offering potential clinical benefits and contributing to the expansion of the donor pool.

Research on Vehicle Path Planning Method with Time Windows in Uncertain Environments

With the growing complexity of logistics and the demand for sustainability, the vehicle routing problem (VRP) has become a key research area. Classical VRPs now incorporate practical challenges such as time window constraints and carbon emissions. In uncertain environments, where many factors are stochastic or fuzzy, optimization models based on uncertainty theory have gained increasing attention. A single-objective optimization model is proposed in this paper to minimize the total cost of VRP in uncertain environments, including fixed costs, transportation costs, and carbon emission costs. Practical constraints like time windows and load capacity are incorporated, and uncertain variables, such as carbon emission factors, are modeled using normal distributions. Two uncertainty models, based on the expected value and chance-constrained criteria, are developed, and their deterministic forms are derived using the inverse distribution method. To solve the problem effectively, a hybrid ant colony–zebra optimization algorithm is proposed, integrating ant colony optimization, zebra optimization, and the 3-opt algorithm to enhance global search and local optimization. Numerical experiments demonstrate the superior performance of the hybrid algorithm, achieving lower total costs compared to standalone ant colony, zebra optimization, genetic algorithm, and particle swarm optimization algorithms. The results highlight its robustness and efficiency in addressing complex constraints.

WASTE MANAGEMENT PRACTICES IN CONSTRUCTION FIRMS: A CASE STUDY OF TRIACTA NIGERIA LTD IN BAUCHI, NIGERIA

This study investigates the impact of construction firms' waste management practices. It focuses on Triacta Nigeria Ltd in Bauchi. The study utilised a survey research design and collected data from 84 permanent staff members to understand their perceptions and experiences related to waste management practices. The findings reveal that significant types of construction waste generated include demolition materials, excavated earth, and unused materials. While certain recycling techniques exist, their efficiency varies, emphasising the need for improved policy enforcement, trash segregation procedures, and staff training. Key challenges identified include resistance to change, logistical complexities, inadequate infrastructure, and high costs, all of which hinder effective recycling adoption. Based on these findings, the study recommends improving policy implementation, enhancing training programmes, and investing in infrastructure to optimize waste management and promote organisational sustainability. This study offers important insights for stakeholders aiming to improve construction waste management practices.

Optimizing food transportation processes for grocery stores across the US

In the rapidly evolving landscape of food logistics, optimizing transportation processes for grocery stores across the United States has become paramount to enhancing operational efficiency and ensuring the delivery of high-quality, perishable goods. This article examines the multifaceted challenges inherent in food transportation, including logistical complexities, environmental concerns, and rising operational costs. It highlights the importance of data-driven strategies, such as route optimization and machine learning algorithms, to improve delivery times and reduce waste. Additionally, the integration of advanced technologies, such as Internet of Things (IoT) sensors for temperature monitoring and automation in warehouse management, is explored to enhance the cold chain and ensure food safety. Moreover, the article emphasizes the critical role of strategic partnerships with third-party logistics providers and suppliers in streamlining operations and enhancing overall performance. Through in-depth case studies of successful grocery chains, it illustrates effective practices that have led to significant improvements in food transportation processes. The regulatory landscape surrounding food transportation is also analysed, underscoring compliance with safety standards and sustainability initiatives. Finally, the article looks ahead to future trends, including the potential impact of autonomous vehicles, blockchain technology, and sustainable practices on the food supply chain. By providing a comprehensive overview of best practices and innovative solutions, this article aims to equip grocery store operators and stakeholders with actionable insights to optimize their food transportation processes, ultimately leading to improved customer satisfaction and reduced environmental impact.

CHALLENGES AND OPPORTUNITIES FOR THE DEVELOPMENT OF LOGISTICS HUBS IN UKRAINE

Logistics, as a key element of modern supply chains, is increasingly becoming the subject of deep engineering research and development. The construction of logistics complexes in today's world is a critical aspect for the development and functioning of global economic systems, as it allows optimizing supply chains and organizing logistics processes to meet the high standards of consumers and business partners. Logistics complexes play a crucial role in global trade by ensuring the fast and efficient delivery of goods. The growth of e-commerce volumes enhances their significance, requiring more space for the storage and processing of goods. These complexes are strategically important for enterprises as they contribute to efficiency improvement, delivery time reduction, and cost optimization. Logistic infrastructures provide flexibility to respond to changing market conditions and support competitiveness at the international level. Accordingly, the construction of logistics complexes plays a strategic role in economic development and supports global business. Objective: The work aims to assess, analyze, and justify organizational-technical factors in optimizing the construction of logistics complexes. Research Object: Construction of logistics complexes as part of modern supply chains and their role in global economic systems. Research Subject: Organizational-technical factors influencing the process of construction of logistics complexes, as well as methods for their optimization to enhance the efficiency and competitiveness of logistic systems. Presentation of Material: To achieve the research objective, the following tasks were performed: analyzed the current state of warehouse logistics in Ukraine and the role of logistic hubs; analyzed the impact of innovative and sustainable materials on the construction of logistics complexes; studied the provision of flexibility and adaptability of logistics complexes to changing market conditions; analyzed resource utilization during construction. Research Results: The research results focus on improving organizational and technological aspects of the construction of logistics complexes through effective management of construction processes, implementation of innovative technologies, and optimization of resource utilization. Such measures contribute to increased productivity and competitiveness of logistic systems, as well as sustainable development and enhanced efficiency of the supply chain.

Donor age and ischemic time in heart transplantation – implications for organ preservation

IntroductionThe Organ Care System and Non-ischemic Heart Preservation methods have emerged as significant advancements in heart transplantation, designed to mitigate ischemic injury and extend preservation times. However, their high costs and logistical complexities necessitate strategic utilization. MethodsWe evaluated data from 83,761 heart transplants registered in the International Society for Heart and Lung Transplantation registry from 1988 to 2018. Utilizing a Cox proportional hazards model, we explored the influence of donor age and ischemic time on transplant survival. A key innovation of our study is the development of a nomogram to predict post-transplant survival, incorporating both traditional and advanced statistical methods. ResultsThe median age of recipients was 52 years (22% female) and 33 years (31% female) for donors. Analysis revealed a median ischemic time of 3 hours and median survival of 11.5 years across the cohort. The nomogram showed a decline in survival probabilities with increasing donor age, notably from age 40 and more significantly with ischemic times >4 hours. Ischemic times ≥4 hours versus <2 hours were associated with hazard ratio (HR) of 1.2 (95% CI, 1.1-1.3) for donors aged 40-59, a disparity that escalated for donors aged ≥60 (HR: 2.0; 95% CI, 1.5-2.7). ConclusionThis study highlights the importance of careful donor selection and indicates that certain groups, particularly older donors with prolonged ischemic times, might benefit from ex-vivo preservation techniques. The developed nomogram offers a practical tool for clinicians, enhancing decision-making by providing detailed insights into the relationship between donor age, ischemic time, and post-transplant mortality.

Photovoltaic pumping tests: A novel supervision method for photovoltaic water pumping systems

Water pumps powered by photovoltaic energy, often named ‘photovoltaic water pumping systems’ (PVWPS), offer a promising solution for improving water access in developing regions. Regular pumping tests are essential for characterizing boreholes and ensuring sustainable groundwater extraction. Traditionally, these tests are conducted only at the time of PVWPS installation using diesel pumps. However, since PVWPS typically have a lifespan of around 20 years, the borehole's condition may change over time, necessitating ongoing testing. To overcome this challenge, this article presents a novel method for conducting pumping tests using the PVWPS's own photovoltaic modules as the power source, greatly simplifying regular borehole monitoring over the PVWPS's lifespan. This approach improves the long-term technical sustainability of PVWPS. By eliminating the need for diesel generators, it reduces also costs, emissions, and logistical complexity while ensuring continuous water supply during testing. The principle and protocol for these proposed tests are outlined, as well as the key indicators for analysis. Furthermore, the associated costs and benefits are thoroughly explored. The proposed method is applied to a PVWPS in a village in Burkina Faso. This PVWPS has 750 Wp of photovoltaic modules, a 10 m³ water tank, and a 56 m borehole. Results show that the photovoltaic pumping tests allow to accurately determine borehole parameters, achieving a model fit with an average R2 of 0.99. Additionally, a photovoltaic pumping test costs $43, which is significantly lower than standard pumping tests: a multiple step drawdown test costs $511 and a long pumping test costs $2050. Moreover, the proposed photovoltaic pumping tests can prevent premature replacements of PVWPS components, leading to significant savings. While demonstrated in a specific context, this method is transferable to other systems, offering potential benefits for companies, local authorities, governments, and NGOs involved in the development and maintenance of PVWPS in rural areas.

Identifying Barriers to Implementing Complementary and Integrative Health Therapies in Rhode Island Health Care Systems: A Qualitative Approach.

Introduction: Complementary and integrative health (CIH) therapies are widely used and make up billions of dollars in out-of-pocket expenditures. This quality improvement project aimed to identify stakeholders' perceptions of implementing CIH therapies in health care systems to examine the barriers and facilitators to CIH implementation in Rhode Island (RI). Methods: A qualitative approach guided by the Consolidated Framework for Implementation Research (CFIR) was used to conduct interviews with key stakeholder groups: health care administrators, health insurance administrators, physicians, and CIH practitioners. Interviews were analyzed by directed content analysis of transcripts with CFIR as the a priori coding framework. Results: Eleven subconstructs within four major domains were most prominent in interviews across all stakeholder groups. Key barriers in the "innovation" domain include a perceived lack of evidence and credibility of CIH therapies, logistical and administrative complexity of implementation, high costs to patients, and little financial incentive for hospitals and insurance companies. The "outer setting" domain highlights the utility of market pressure in decision making to implement CIH and the role of health policy. The "inner setting" domain demonstrates the varied personal beliefs about CIH, credentialing challenges, and the dissonance between medical system priorities and patient needs. Positive facilitation of implementation is marked by personal exposure to CIH and provider satisfaction in the "implementation process" domain. Conclusion: CIH therapies offer the medical system low risk and effective interventions that meet patient needs not currently met by Western medicine. However, implementation is difficult due to poor perception of evidence and lack of financial gain for the medical system. Acupuncture and massage may be modalities better situated for implementation in the RI medical system. Further education, awareness, and advocacy for CIH therapies would help meet patients' needs for CIH availability.

Contesting the Anticipated Infrastructural City: A Grounded Analysis of Silk Road Urbanization in the Multipurpose Port Terminal in Chancay, Peru

A new private port and logistics complex is under construction in the city of Chancay, located north of Lima, Peru, as part of China’s Belt and Road Initiative (BRI) promising to change life in the city while expanding a Sino-centric globalized economy and Peru’s reach within it. Through a series of interviews conducted between 2020 and 2022 and document analysis, we seek to offer a grounded theorization of how the BRI, as an exemplar of infrastructure-led urbanization, interweaves with broader sociospatial and socionatural transformations, affecting the present and future of the places where it materializes. By using the concept of the infrastructural city we show how the combination of port and logistics infrastructures with spatial interventions in periurban space is guiding contemporary urbanization, resulting in the formation of a new, amorphous city that has as its defining characteristic the domination of infrastructure over urban life, eradicating prior functions and marginalizing local grievances to facilitate the creation of a privatized enclave for international trade. Our analysis provides insights into the intricate and multifaceted geographies of emerging Chinese-sponsored infrastructural strategies, the hopes and struggles that contextually shape them, and the potentially distinctive and contested urban features of the anticipated infrastructural cities yet to come.